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Digestion 2021Severe acute pancreatitis (AP) continues to be a serious gastrointestinal disease with relevant morbidity and mortality. (Review)
Review
BACKGROUND
Severe acute pancreatitis (AP) continues to be a serious gastrointestinal disease with relevant morbidity and mortality.
SUMMARY
Successful clinical management requires close interdisciplinary cooperation and coordination from experienced gastroenterologists, intensive care physicians, surgeons, and radiologists. While the early phase of the disease is characterized by intensive care aspects that focus primarily on treatment of organ failure, later complications are characterized especially by (infected) necrotic collections. Here, we discuss current clinical standards and developments for conservative and interventional management of patients with severe AP. Key messages: Early targeted fluid therapy within the first 48 h is critical to improve the outcome of severe AP. Thoracic epidural analgesia may have prognostically beneficial effects due to suspected anti-inflammatory effects and increased perfusion of splanchnic vessels. Enteral feeding should be started early during severe AP. Persistent organ failure (>48 h) is the strongest predictor of poor prognosis, and local complications such as infected walled-off necrosis should be primarily treated by minimally invasive endoscopic step-up approaches that are usually superior to surgical therapy options.
Topics: Acute Disease; Humans; Pancreatitis
PubMed: 32422634
DOI: 10.1159/000506830 -
Patient Education and Counseling Jul 2016To use meta-analytic techniques to assess average effect sizes in studies of: (1) the correlation between patient health literacy and both medication and non-medication... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To use meta-analytic techniques to assess average effect sizes in studies of: (1) the correlation between patient health literacy and both medication and non-medication adherence, and (2) the efficacy of health literacy interventions on improving health literacy and treatment adherence.
METHODS
PsychINFO and PubMed databases were searched (1948-2012). A total of 220 published articles met the criteria for inclusion; effect sizes were extracted and articles were coded for moderators.
RESULTS
Health literacy was positively associated with adherence (r=0.14), and this association was significantly higher among non-medication regimens and in samples with cardiovascular disease. Health literacy interventions increased both health literacy (r=0.22) and adherence outcomes (r=0.16). Moderator analyses revealed greater intervention efficacy when health literacy and adherence were assessed using subjective measures compared to objective measures. Health literacy interventions had a greater effect on adherence in samples of lower income and of racial-ethnic minority patients than in non-minority and higher income samples.
CONCLUSION
This is the first study to synthesize both correlational and intervention studies examining the relationship between health literacy and adherence to both medication and non-medication regimens.
IMPLICATIONS
These findings demonstrate the importance of health literacy and the efficacy of health literacy interventions especially among more vulnerable patient groups.
Topics: Acute Disease; Cardiovascular Diseases; Chronic Disease; Health Literacy; Humans; Outcome Assessment, Health Care; Patient Compliance; Patient Education as Topic
PubMed: 26899632
DOI: 10.1016/j.pec.2016.01.020 -
The New England Journal of Medicine Mar 2018Comparative clinical effects of balanced crystalloids and saline are uncertain, particularly in noncritically ill patients cared for outside an intensive care unit (ICU). (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Comparative clinical effects of balanced crystalloids and saline are uncertain, particularly in noncritically ill patients cared for outside an intensive care unit (ICU).
METHODS
We conducted a single-center, pragmatic, multiple-crossover trial comparing balanced crystalloids (lactated Ringer's solution or Plasma-Lyte A) with saline among adults who were treated with intravenous crystalloids in the emergency department and were subsequently hospitalized outside an ICU. The type of crystalloid that was administered in the emergency department was assigned to each patient on the basis of calendar month, with the entire emergency department crossing over between balanced crystalloids and saline monthly during the 16-month trial. The primary outcome was hospital-free days (days alive after discharge before day 28). Secondary outcomes included major adverse kidney events within 30 days - a composite of death from any cause, new renal-replacement therapy, or persistent renal dysfunction (defined as an elevation of the creatinine level to ≥200% of baseline) - all censored at hospital discharge or 30 days, whichever occurred first.
RESULTS
A total of 13,347 patients were enrolled, with a median crystalloid volume administered in the emergency department of 1079 ml and 88.3% of the patients exclusively receiving the assigned crystalloid. The number of hospital-free days did not differ between the balanced-crystalloids and saline groups (median, 25 days in each group; adjusted odds ratio with balanced crystalloids, 0.98; 95% confidence interval [CI], 0.92 to 1.04; P=0.41). Balanced crystalloids resulted in a lower incidence of major adverse kidney events within 30 days than saline (4.7% vs. 5.6%; adjusted odds ratio, 0.82; 95% CI, 0.70 to 0.95; P=0.01).
CONCLUSIONS
Among noncritically ill adults treated with intravenous fluids in the emergency department, there was no difference in hospital-free days between treatment with balanced crystalloids and treatment with saline. (Funded by the Vanderbilt Institute for Clinical and Translational Research and others; SALT-ED ClinicalTrials.gov number, NCT02614040 .).
Topics: Acute Disease; Adult; Aged; Cross-Over Studies; Electrolytes; Emergency Service, Hospital; Emergency Treatment; Female; Fluid Therapy; Hospitalization; Humans; Isotonic Solutions; Kidney Diseases; Male; Middle Aged; Renal Replacement Therapy; Ringer's Lactate; Sodium Chloride
PubMed: 29485926
DOI: 10.1056/NEJMoa1711586 -
Acta Cardiologica Apr 2024
Topics: Humans; Coronary Artery Disease; Myocardial Ischemia; Risk Factors; Chronic Disease; Acute Disease
PubMed: 38628088
DOI: 10.1080/00015385.2024.2339011 -
British Journal of Sports Medicine Sep 2016The modern-day athlete participating in elite sports is exposed to high training loads and increasingly saturated competition calendar. Emerging evidence indicates that...
The modern-day athlete participating in elite sports is exposed to high training loads and increasingly saturated competition calendar. Emerging evidence indicates that inappropriate load management is a significant risk factor for acute illness and the overtraining syndrome. The IOC convened an expert group to review the scientific evidence for the relationship of load-including rapid changes in training and competition load, competition calendar congestion, psychological load and travel-and health outcomes in sport. This paper summarises the results linking load to risk of illness and overtraining in athletes, and provides athletes, coaches and support staff with practical guidelines for appropriate load management to reduce the risk of illness and overtraining in sport. These include guidelines for prescription of training and competition load, as well as for monitoring of training, competition and psychological load, athlete well-being and illness. In the process, urgent research priorities were identified.
Topics: Acute Disease; Athletes; Athletic Injuries; Athletic Performance; Biomarkers; Cumulative Trauma Disorders; Diet, Healthy; Evidence-Based Medicine; Female; Health Promotion; Humans; Immune System; Male; Physical Education and Training; Practice Guidelines as Topic; Professional Practice; Return to Sport; Risk Factors; Sports Medicine; Stress, Psychological; Terminology as Topic; Travel; Workload
PubMed: 27535991
DOI: 10.1136/bjsports-2016-096572 -
The Lancet. Respiratory Medicine Jun 2021
Topics: Acute Disease; COVID-19; Humans; Phenotype; SARS-CoV-2
PubMed: 34089668
DOI: 10.1016/S2213-2600(21)00242-3 -
Frontiers in Immunology 2022Acute pancreatitis is a common gastrointestinal disease characterized by inflammation of the exocrine pancreas and manifesting itself through acute onset of abdominal... (Review)
Review
Acute pancreatitis is a common gastrointestinal disease characterized by inflammation of the exocrine pancreas and manifesting itself through acute onset of abdominal pain. It is frequently associated with organ failure, pancreatic necrosis, and death. Mounting evidence describes monocytes - phagocytic, antigen presenting, and regulatory cells of the innate immune system - as key contributors and regulators of the inflammatory response and subsequent organ failure in acute pancreatitis. This review highlights the recent advances of dynamic change of numbers, phenotypes, and functions of circulating monocytes as well as their underling regulatory mechanisms with a special focus on the role of lipid modulation during acute pancreatitis.
Topics: Humans; Monocytes; Acute Disease; Pancreatitis, Acute Necrotizing; Inflammation
PubMed: 36578487
DOI: 10.3389/fimmu.2022.1062849 -
Frontiers in Immunology 2023Acute pancreatitis (AP) is one of the most common inflammatory diseases of the gastrointestinal tract and a steady rising diagnosis for inpatient hospitalization. About... (Review)
Review
Acute pancreatitis (AP) is one of the most common inflammatory diseases of the gastrointestinal tract and a steady rising diagnosis for inpatient hospitalization. About one in four patients, who experience an episode of AP, will develop chronic pancreatitis (CP) over time. While the initiating causes of pancreatitis can be complex, they consistently elicit an immune response that significantly determines the severity and course of the disease. Overall, AP is associated with a significant mortality rate of 1-5%, which is caused by either an excessive pro-inflammation, or a strong compensatory inhibition of bacterial defense mechanisms which lead to a severe necrotizing form of pancreatitis. At the time-point of hospitalization the already initiated immune response is the only promising common therapeutic target to treat or prevent a severe disease course. However, the complexity of the immune response requires fine-balanced therapeutic intervention which in addition is limited by the fact that a significant proportion of patients is in danger of development or progress to recurrent and chronic disease. Based on the recent literature we survey the disease-relevant immune mechanisms and evaluate appropriate and promising therapeutic targets for the treatment of acute and chronic pancreatitis.
Topics: Humans; Acute Disease; Pancreatitis, Chronic; Disease Progression
PubMed: 37881430
DOI: 10.3389/fimmu.2023.1279539 -
CMAJ : Canadian Medical Association... Mar 2024
Topics: Humans; Scleritis; Pamidronate; Uveitis, Anterior; Acute Disease
PubMed: 38527748
DOI: 10.1503/cmaj.230859-f -
Revista Da Associacao Medica Brasileira... Feb 2022
Topics: Acute Disease; Appendectomy; Appendicitis; Humans
PubMed: 35239865
DOI: 10.1590/1806-9282.20211315